Diverticulitis: Symptoms, Concerns, and Diagnosis - Gastroenterology and Hepatology

Q: Diverticulitis: Symptoms, Concerns, and Diagnosis

Hello： 1. <br>If the pain subsides after a bowel movement or lasts only for a brief moment, there is usually no need for excessive concern; typically, if there is a problem, the pain would persist. <br>2. <br>Bloating or fecal impaction can also present similar symptoms. <br>3. <

Questions related to diverticulitis?

Hello Doctor, I discovered in my company's health check report in January 2019 that I had a positive fecal occult blood test with a level of 200.
However, I did not undergo a colonoscopy and later went abroad.
Prior to this, I had never experienced abdominal pain, rectal bleeding, or any gastrointestinal issues, except for occasional constipation, having bowel movements twice a week.
There is no family history of colorectal cancer, and my diet has been relatively balanced, with five servings of fruits and vegetables daily.
I do not eat meat often, but after graduating from college and starting work, I consumed fewer fruits and vegetables and often ate out, averaging one to two servings of fried food per week.

At the end of November 2019, I experienced abdominal pain in the lower right side and went to the emergency room abroad, where I had a CT scan and blood and urine tests.
The doctor diagnosed me with diverticulitis.
After taking antibiotics for a week, my condition improved, but I continued to have diarrhea for one to two months before my bowel movements returned to normal.
Because a colonoscopy abroad was too expensive and I faced difficulties returning to Taiwan due to the pandemic, I have not had one.

(1) I would like to ask the doctor about occasional mild abdominal pain I experience, which lasts only a few seconds.
I am unsure if it is related to digestion.
Sometimes, I feel significant pain in my abdomen before a bowel movement, but it resolves after I go to the bathroom.
What could this indicate?
(2) Recently, I have experienced pain when pressing on the left side near my navel, which later shifted to pain on the right side of my navel and a few inches below it.
The pain only occurs when I press on those areas and lasts for one to two weeks before disappearing.
Could this be related to stool in my intestines, or is it a symptom of another condition?
(3) I have been observing my stool and am uncertain if there is blood in it.
My stool is banana-shaped and yellow or yellow-brown in color, but it often contains small red specks.
I am unsure if these are blood streaks or food remnants.
I wonder if this is related to my occasional consumption of spicy food, daily intake of dried cranberries, tomatoes, and smoothies made with frozen berries (which I eat daily or every couple of days).
Most of my stool appears normal, but upon closer inspection, there are times when a small part seems slightly reddish.
Is this normal due to dietary influences, or could it indicate colorectal cancer or be related to diverticulitis, or am I overreacting?
(4) Is there a connection between the positive fecal occult blood test and the subsequent diagnosis of diverticulitis, or could there be other potential diseases?
(5) Given that the CT scan indicated diverticulitis, is there a possibility that colorectal cancer was misdiagnosed? If there were a tumor or polyp, would it be visible on the CT scan? (I am genuinely worried about colorectal cancer and do not doubt the doctor's diagnosis.
😭) Thank you, Doctor, for your patience in reading this!

Bearcc, 20~29 year old female. Ask Date: 2020/11/28

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If the pain subsides after a bowel movement or lasts only for a brief moment, there is usually no need for excessive concern; typically, if there is a problem, the pain would persist.
2.
Bloating or fecal impaction can also present similar symptoms.
3.
The presence of red in the stool is more concerning; if there is bleeding, the water should appear red immediately.
4.
There are many possibilities for a positive fecal occult blood test, and a colonoscopy is necessary to confirm the diagnosis.
5.
A CT scan cannot diagnose small polyps; to definitively diagnose colorectal cancer, a colonoscopy is essential.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/11/28

More Info

Understanding diverticulitis and its implications can be quite complex, especially when considering your medical history and symptoms. Let’s break down your concerns systematically.

1. Symptoms of Diverticulitis: Diverticulitis occurs when diverticula, which are small pouches that can form in the walls of the colon, become inflamed or infected. Common symptoms include abdominal pain (often on the left side), fever, nausea, and changes in bowel habits, such as diarrhea or constipation. Your description of occasional mild abdominal pain, which resolves quickly, and more significant pain before bowel movements could be related to your diverticulitis. The pain you experience may be due to the bowel's contractions as it moves stool, especially if there are diverticula present.

2. Localized Pain: The pain you mentioned on the left side near the navel and then shifting to the right side could be indicative of several things. It might be related to the diverticula or could be due to other gastrointestinal issues, such as gas or constipation. If the pain is transient and only occurs upon palpation, it may not be a cause for immediate concern, but it’s essential to monitor it. If it persists or worsens, further evaluation would be warranted.

3. Stool Appearance: The changes in your stool, particularly the presence of red specks, could be concerning. It’s essential to differentiate between blood and food residue. Foods like tomatoes or certain berries can sometimes cause changes in stool color. However, if you notice consistent red streaks or if the stool appears darker or tarry, it could indicate bleeding in the gastrointestinal tract, which should be evaluated by a healthcare professional.
4. Connection Between Positive Fecal Occult Blood Test and Diverticulitis: A positive fecal occult blood test (FOBT) indicates the presence of blood in the stool, which can be due to various reasons, including diverticulitis, hemorrhoids, or even polyps and cancers. While diverticulitis can cause bleeding, it’s crucial to investigate further, especially since you have a history of a positive FOBT.
5. CT Scan and Cancer Concerns: CT scans are quite effective in diagnosing diverticulitis and can also identify masses, tumors, or polyps. However, they are not foolproof. While a CT scan can show signs of diverticulitis, it may not always detect small tumors or early-stage cancers. If there is a significant concern, a colonoscopy is the gold standard for visualizing the colon and obtaining biopsies if necessary.
Given your history and symptoms, it’s essential to follow up with a gastroenterologist. They may recommend a colonoscopy to rule out any malignancies or other conditions, especially considering your previous positive FOBT and the recent episode of diverticulitis.
In summary, while your symptoms may be related to diverticulitis, it’s crucial to have a thorough evaluation to rule out any serious conditions. Regular monitoring and appropriate diagnostic tests will help ensure that any potential issues are addressed promptly. Please consult with your healthcare provider to discuss your symptoms and the best course of action.

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